Mary Foote, MD, MPH Senior Health Security Specialist Bureau of Healthcare System Readiness COVID-19 19 Krishika A. Graham, MD, MPH HEALTHC HCARE RE Adult Immunization Medical Specialist Bureau of Immunization PROVIDER ER Shirley Huie, MPH UPDATE Online Registry Manager Bureau of Immunization A UGUST 7, 2020 New York City Department of Health and Mental Hygiene Our understanding of COVID-19 is evolving rapidly. This presentation is based on our knowledge as of August 6, 2020, 5 PM.
CME Accreditation Statement for Joint Providership NYC Health + Hospitals is accredited by The Medical Society of the State of New York (MSSNY) to provide continuing medical education for physicians. This activity has been planned and implemented in CONT NTINU NUING NG accordance with the Accreditation Requirements and MEDICA ME CAL Policies of the MSSNY through the joint providership of NYC Health + Hospitals and the NYC Department of EDU DUCATION Health and Mental Hygiene. NYC Health + Hospitals designates this continuing medical education activity for a maximum of 1 AMA PRA Category 1 Credit TM . Physicians should claim only credit commensurate with the extent of their participation in the activity.
WHERE WE ARE NOW GETTING READY FOR FLU SEASON OUTLINE FLU VACCINATION DURING THE COVID-19 PANDEMIC CITYWIDE IMMUNIZATION REGISTRY REPORTING QUESTIONS AND DISCUSSION
Mary Foote, MD, MPH WH WHERE WE WE Health Systems Planning and Strategies Lead , ARE N NOW OW COVID-19 Response NYC Department of Health and Mental Hygiene
• Over 18 million cases and 693,000 deaths due to COVID-19 confirmed worldwide • The United States reported a record 1.87 million cases in July WHERE HERE • Vaccine candidates are in various stages of development. WE WE A ARE Moderna/NIH and AstraZeneca/Oxford University vaccines are in stage III trials NOW • Indicators of viral circulation in NYC are being monitored closely to gauge success of suppression measures and to help guide potential next steps in reopening
CUMULATIVE CASES WORLDWIDE >18.2 million cases >693,000 deaths 8/3/20 Cumulative confirmed cases, Johns Hopkins University https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6
CUMULATIVE CASES AND DEATHS, U.S. 8/3/20 > 4.8 million cases (~26% of confirmed global cases) > 158,000 deaths (~23% of reported global deaths) New York Times. Coronavirus in the U.S.: total cases. https://www.nytimes.com/interactive/2020/us/coronavirus-us-cases.html
CASES COVID-19, NYC 8/3/20 Cumulative counts: • Cases: 222,522 • Hospitalizations: 56,365 HOSPITALIZATIONS • Confirmed deaths: 18,927 • Probable deaths: 4,623 Figures show number of daily COVID- 19 cases, hospitalizations, and deaths DEATHS NYC Health Department. COVID-19: data. https://www1.nyc.gov/site/doh/covid/covid-19-data.page
Mary Foote, MD, MPH GE GETTING R G READY Health Systems Planning and Strategies Lead , FOR F FLU LU COVID-19 Response NYC Department of Health and Mental Hygiene
• Framing the problem • Getting your facility ready • Evaluation and management considerations OUTLIN INE • What is the NYC Health Department doing to prepare • Flu down south
Seasonal F Flu and respiratory s syncytial virus us ( (RSV) SV) • Each year, the beginning, peak, and end of the flu season are different • Flu activity often starts in October and peaks in February most seasons • RSV typically peaks a bit earlier than influenza • Influenza sometimes exhibits two separate peaks in a season NYC Influenza Surveillance Report 11
https://www.cdc.gov/flu/about/burden/preliminary-in-season-estimates.htm
• Potential second wave of COVID-19 in the fall • Compounding strain on healthcare system capacity • Higher risk to black and brown communities SEASO SONAL L • Overlap in symptoms / presentation INF NFLUENZA + A + • COVID-19 testing challenges persist COV OVID-19 • Impact of dual respiratory infections unknown = = SYNDEMI MIC • Are recovered COVID-19 patients more vulnerable? • Could exacerbate shortages of PPE and other supplies
• Convene planning team • Review flu and COVID-19 plans • Incorporate lessons learned from 1 st wave • Optimize influenza vaccination • Explore testing options GE GETTING R G READY • Assess supply needs • Supply needs based on peak of COVID-19 • What would be impacted when you add other respiratory infections into the mix? • Begin patient communications early
• Could help reduce strain on healthcare system and supply chain • Proactive outreach to patients at highest risk for severe COVID-19 • Similar risk factors for severe flu VACCIN INATIO ION • Consider dedicated vaccine clinic hours • Offer to asymptomatic and mildly symptomatic patients presenting for COVID-19 testing • Ensure providers have the education and tools to address vaccine hesitancy
Disparities es i in Flu Vaccinati tion R Rates nfluenza during the COVID-19 Pandemic NYC COVID-19 Case Rates as of 8/4/2020 NYC Influenza Vaccine Coverage, 2017
• Create standard processes for • Testing (symptomatic vs. asymptomatic) • Vaccination • Screen for COVID-19 symptoms before appointments • Would telehealth visit be appropriate? • Does your facility offer COVID-19 testing? PATIENT T TRIAGE GE • If yes, would hybrid visit be appropriate? AND F FLO LOW • If no, can assessment be done remotely and patient referred to designated testing site? • Screen everyone for symptoms upon arrival • Direct symptomatic patients to a designated isolation area • Prepare signage and post staff for directing patients • Ensure physical distancing throughout https://www1.nyc.gov/site/coronavirus/get-tested/covid-19-testing.page
• Consider the use of alternate spaces • Tents outside of the facility • Community spaces for vaccination clinics • Designate separate waiting and consultation areas for patients with respiratory symptoms within facility • Designate one clinic site for respiratory illness SPA PACE evaluation CO CONSIDERATIONS • Establish designated hours for sick visits • Assess and optimize air circulation and ventilation in shared spaces • Consider the use of portable solutions (e.g., HEPA filter units) to create negative pressure space
• Refresher training for staff • Fit testing needs of staff • Are potentially aerosol generating procedures being performed? • Cohorting of patients and staff • Universal source control INFE FECTI CTION CONTRO ROL • Facemasks for all staff • Facemask or face covering for patients and visitors CONSIDERATIONS CO • Ensure adequate supplies • Hand sanitizer throughout facility including by entryway of every patient room • PPE should include facemask and eye protection for all clinical encounters https://www1.nyc.gov/assets/doh/downloads/pdf/imm/covid-19-infection-control-outpatient.pdf
• Plan for staff shortages • What activities can be suspended if needed • Cross train staff to perform essential roles • Symptom monitoring ST STAFFI FFING • Before start of each shift • What’s the protocol if symptoms reported? CO CONSIDERATIONS • Review options for temporary staffing • Medical reserve corps • Other volunteers • Temporary staffing agencies
• Current strain on local and national testing capacity • Turnaround times significantly prolonged • Testing stewardship: will result change my management? • Testing options • Point of care options SARS-CoV-2 PCR or antigen • Combined tests SARS-CoV-2 + Flu +/- RSV • Other rapid tests Strep A, Flu, RSV TESTIN TE ING • Point of care test results are preliminary CONSIDERATIONS CO • Need confirmation with lab-based PCR test • Influenza diagnosis does not rule out COVID-19 • Co-infections with SARS-CoV-2 and other viruses are well documented • If suspicion high, treat as COVID-19 while awaiting test results
• Develop management algorithms • Assess risk and symptom severity • Testing capabilities • Treatment options • Monitoring and follow-up plans • Equipment and supply needs OUTPATIENT • Pulse oximeters MANAG NAGEMENT • Home oxygen CONSIDERATIONS CO • Empiric treatment for flu • Oral Oseltamivir • Oral baloxavir (Xofluza TM) • Ensure ability to safely isolate • Consider social support needs https://www1.nyc.gov/assets/doh/downloads/pdf/covid/providers/covid-19-providers-id-adults-severe-risk-outpatient.pdf
• Equity-centered approach • Providing healthcare guidance • Increasing access to rapid SARS-CoV-2 testing and support services HO HOW IS T THE HE NY NYC • Increasing influenza vaccine uptake HEALT LTH • Planning for COVID-19 vaccine rollout DEPARTMENT DE • Supporting City PPE and ventilator stockpile planning PREPAR ARING? G? • Supporting healthcare surge planning • Enhanced surveillance and improving data collection • Maintaining essential healthcare services during a second wave
2020 F Flu Sea eason: P Positiv ive S Signs? Southern Hemisphere Northern Hemisphere
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